COMPILED BY MILES Z. EPSTEIN, EDITOR, COMMERCE
GIVEN MARKET TRENDS AND a growing reliance on technology, COMMERCE asked New Jersey’s top hospital CEOs to address the following question: What is your strategy for encouraging innovation in healthcare and patient care? The following industry leaders participated in this Annual Hospital CEO Roundtable:
● Atlantic Health System President and CEO Brian Gragnolati, FACHE;
● CentraState Healthcare System President and CEO John T. Gribbin, FACHE;
● Englewood Health President and CEO Warren Geller;
● Hackensack Meridian Health CEO Robert C. Garrett, FACHE;
● Holy Name Medical Center President and CEO Michael Maron;
● RWJBarnabas Health President and CEO Barry H. Ostrowsky;
● Trinitas Regional Medical Center President and CEO Gary S. Horan, FACHE;
● Valley Health System President and CEO Audrey Meyers.
Atlantic Health System By Brian Gragnolati, FACHE, President and CEO
Innovation is a critical component in improving quality, advancing affordability and increasing efficiency. In 2017, we launched Atlantic Health Advance-ments—AHa!—to inspire our workforce of 17,000 team members and 4,800 physicians to generate ideas and inventions that enhance care delivery and improve clinical outcomes. Selected ideas receive engineering and prototyping support. Our care delivery innovations vary widely across clinical areas. AHa!’s first advancement, the Insulin Safety Secure Initiative or ISSI® Box, significantly reduces waste by creating a clear process for labeling and storing insulin between shifts, reducing the need to continually open new vials. Yet another AHa! success story is the Lighted Polyhedral Retractor, developed to create space around the thyroid during surgery, allowing surgeons to operate in a wider field, away from veins and blood vessels. The retractor is now being expanded for additional uses. To continually advance new thinking and resourcefulness throughout our organization, we hired Sylvia Romm, M.D., MPH, as our new Chief Innovation Officer. Romm is already working hard to build relationships with local and national innovation partners, while furthering our system’s research profile.
CentraState Healthcare System By John T. Gribbin, FACHE, President and CEO
One of the ways we are innovating patient care is by bringing clinical and social services right into the communities we serve. We recently partnered with the Visiting Nurse Association Health Group, VNACJ Community Health Center, Inc. and Rutgers Robert Wood Johnson Medical School through our Family Medicine Residency Program to create a new Federally Qualified Health Center accessible to all members of the Freehold community, including underserved populations. The Freehold Family Health Center provides comprehensive primary and specialty care, including geriatrics. In the same building, the VNA Children and Family Health Institute offers community health programs such as WIC, programming by the County Councils for Young Children, and cancer education and early detection programs to benefit area residents. Bilingual staff are available to assist with all services. Every facet of the Center is designed to serve as a resource for individuals and families, many of whom may struggle to access care, including a location that is easily accessible by walking or bus routes. We have received excellent feedback from patients who have accessed the Center and will continue to build a healthier community through unique, accessible programming like this in the future.
Englewood Health By Warren Geller, President and CEO
Our strategy is simple: we deliver a healthcare experience that puts patients at the center. This involves participating in clinical trials and adopting emerging technologies for patient care. One example is our success with transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic stenosis. Since the FDA approved the use of TAVR in 2011, we’ve performed more than 500 procedures, making us one of the most experienced centers in New Jersey. And more importantly, this has given very sick members of our community renewed health. We’ve fostered a team approach between interventional cardiologists and cardiothoracic surgeons to perform TAVR procedures. We’ve created a state-of-the-art hybrid operating room with advanced technology to function as both a cardiac catheterization suite and operating room. This provides the safest environment to treat TAVR patients. Recently, the FDA approved the use of TAVR for a wider patient population, so many more patients will benefit from this innovative technology.
Hackensack Meridian Health By Robert C. Garrett, FACHE, CEO
Innovation is in our DNA and we have many strong examples of how this is the key to transforming healthcare. We merged with Carrier Clinic this year to innovate behavioral health care at a time of urgent public need. Our merger will expand access, better coordinate care and innovate treatment. This is essential since one in five Americans struggles with mental health issues. We recently opened New Jersey’s first behavioral health urgent care center and we are on target to open a destination treatment center in Bergen County later this year. We also opened the Center for Discovery and Innovation to break down silos in research, academia and the clinical world to deliver breakthroughs to patients faster. I am also very proud of the Hackensack Meridian School of Medicine at Seton Hall University, which is in its second year and has received national accolades for its innovative curriculum. You can’t transform medicine without redesigning physician education. Our approach includes a three-year path to residency, a community immersion program and inter-disciplinary learning. We are training future doctors to focus on prevention as much as healing. And by connecting with patients early in their training, our graduates will humanize healthcare.
Holy Name Medical Center By Michael Maron, President and CEO
Innovative technologies enable our team to improve our value-based, high-quality patient care, while also ensuring cost efficiencies. Our Data Science team is implementing artificial intelligence solutions using machine learning, statistical models, and algorithms to create predictive models. Projects include identifying rising risk patients in our Accountable Care Organization and then tailoring risk interventions; expanding hepatitis C screenings, preventing and detecting sepsis and optimizing patient throughput and staffing with patient volume forecasting; automating Home Care and Transitional Care patient event notifications (when a patient comes to the ED or skilled nursing facility) to prevent readmissions; and automating Operating Room staff scheduling and daily assignments. Our Institute for Simulation Learning is designing interactive video gaming to educate physicians to accurately communicate patients’ risk assessment for further illness. The ISL also initiated a simulation-based nurse residency program for new graduates, which will aid in combating a national nurse shortage by reducing turnover.
RWJBarnabas Health By Barry H. Ostrowsky, President and CEO
We pursue a collaborative approach to healthcare by combining strategic planning with creative innovation. Key to our success is prioritizing strategic initiatives. Beginning in our own community, we have implemented a bold training program, engaging all 33,000 employees, both clinical and non-clinical, in our commitment to become a High Reliability Organization. We constantly work to advance the long-term well-being of our communities, addressing the social determinants of health to build a more equitable New Jersey. Our Social Impact and Community Investment practice initiatives foster access to healthy food, education and safe housing and with our financial investments contribute to the economic and social viability of vulnerable communities. Our public/ private partnership with Rutgers University, the State University of New Jersey, promotes access to the latest in medical research and treatment technologies, including those at Rutgers Cancer Institute of New Jersey—the state’s only National Cancer Institute-designated comprehensive cancer center. Our Tackling Addiction Task Force is proactively preventing and treating substance use disorder in New Jersey, working to erase the stigma and combat the opioid crisis. LGBTQ services have improved care access, and eight RWJBarnabas Health hospitals were honored with the Healthcare Equality Index designation.
Trinitas Regional Medical Center By Gary S. Horan, FACHE, President and CEO
Encouraging innovation is not just about novelty for the sake of novelty, or simply being able to say we’re different. From the ground up, Trinitas has always been open to innovation. We encourage practitioners to think outside the box and to bring us their best and brightest methods in patient care. This has only made us a more solid entity, as we are not afraid to analyze conventional methods in all areas and make necessary changes to benefit patients and employees. This is also the way we are making our mark on the healthcare industry. For instance, since we purchased the Hana Ortho-pedic Table, we offer total hip replacement patients a more accurate and minimally invasive alternative to conventional hip surgery, with faster recovery time. We would like to think this will set a new industry standard as it becomes more familiar. We continue to increase our application of robotic surgery because of the improved precision for the surgeon and decrease in post-operative pain for the patient. Recently, we performed the first radical tonsillectomy on a patient with oropharynx cancer by using a robotic surgery system that is minimally invasive and affords a much faster recovery.
Valley Health System By Audrey Meyers, President and CEO
We are committed to innovative healthcare practices that enhance patient care and access. Our newly redesigned website, ValleyHealth.com, serves as a portal for helping patients to quickly get the care and information that they need. The site features the ability to make confirmed appointments for mammography, ultrasound, vascular ultrasound and X-rays; view wait times and “save your spot” at all Valley Medical Group walk-in care centers; reserve a time to be seen in our Emergency Department; and activate DispatchHealth, our new service that enables us to provide urgent care to northern New Jersey residents of all ages in the comfort of their homes. To ensure continuity of care, DispatchHealth provides a detailed report to each patient’s primary care physician, living community or home health agency. As an added convenience, the DispatchHealth team can electronically send prescriptions to a patient’s pharmacy if needed. At Valley, we understand that clinical innovation, both in direct care and via telemedicine, is crucial to promoting and improving the well-being of our patients, their families and our community. As such, we will continue to develop and implement novel and cutting-edge tools to further enrich the patient experience.
COMMERCE also asked top accounting firms and law firms to discuss how they are assisting life sciences and healthcare clients to thrive in New Jersey—given the business climate and the competing visons of the Affordable Care Act, Medicare for All and other reforms for this vital and complicated sector. Here are their thoughts and observations.
BDO By Karen Meador, M.D., MBA, Managing Director, Healthcare Advisory Practice
Regardless of what results from the continued debates and uncertainty around the future of the American healthcare system, our advice to our New Jersey healthcare and life sciences clients is to strongly focus their efforts on demonstrating value. That’s both value in terms of improved patient outcomes and return on investment across the entirety of the health system. For example, demonstrating how their pharmaceutical products help prevent costlier care events like transplants, hospital stays or emergency room visits—which make up a large percentage of overall healthcare spend in this country—is key. This becomes especially important when legislation and regulation threaten to further reduce profit margins for pharmaceuticals.
Grassi Healthcare Advisors, LLC By Joseph Tomaino, M.S., RN, Partner, CEO
The various Medicare for All proposals provide a range of potential impact for our healthcare provider clients. For our hospital and physician clients, Medicare reimbursement is at the low end in comparison to commercial managed care plans, and an environment where Medicare rates are the standard for all payment could be devastating. For our post-acute care clients, skilled nursing facilities and home care agencies, Medicare rates are fairly good, and they would not be impacted as severely. Our advice to all our clients is to monitor the political environment and be alert to potential changes on the horizon. Regardless of what model evolves, we stress that clients should continue to pursue clinical innovation with good outcomes and few complications while, at the same time, watching costs closely and driving productivity and efficiency. We are strong on people development as well as leveraging technology to improve care processes and delivery.
Sax LLP By Susan E. Reed, CPA, CFP, Partner-in-Charge, Healthcare Practice
We advise physician groups of all sizes and specialties in every important area of their business, including reimbursements and driving efficiencies. To maximize reimbursements, we advise our clients to participate in payor programs, such as quality improvement programs to garner incentive payments. If they are too small to negotiate directly with payors, we advise them to consider joining an IPA (independent physician association), ACO (accountable care organization) or other physician organizations to negotiate reimbursements from a position of strength. Practices also need to know their payor contracts, so they do not get denied reimbursement for their work due to avoidable missteps, such as timely filing issues. To drive efficiency throughout the practice, we advise our clients to step back and rethink processes in all areas of their practice to eliminate any unnecessary procedures. We also advise clients to increase efficiency with technology. From automated patient appointment reminders, to downloading bank account activity directly into billing and accounting software, there are a myriad of ways to eliminate manual, time-consuming work. We push our clients to also evaluate profitability of services provided to ensure they should be continued and consider using mid-level providers where appropriate to free physicians up to do more profitable work.
Brach Eichler LLC By Joseph M. Gorrell, Esq., Member, Healthcare Law Practice
In today’s healthcare environment, the predominant certainty is uncertainty. Given the high cost of healthcare and the politico-legal environment—including the possibility that the Affordable Care Act might be ruled unconstitutional—our advice to our clients is to carefully analyze their present and future needs and to explore all available options. Physicians in private practice can take several paths and their choice will depend on many factors, including, for example, their remaining years of practice; the financial stability of their practice; the fees they are able to negotiate from insurance carriers; and the administrative burdens of operating their practice. For those in single or small practices, the administrative burden and level of reimbursement increasingly will cause physicians to seek other alternatives. That is somewhat less of an imperative for those in large practices. For those nearing the end of their careers, it is wise to focus on a suitable exit strategy. Options range from hospital affiliations (employment or leased employees) to specialty group mergers, to large multispecialty groups to private equity purchase. No one option is suitable for all physicians, and many will choose to continue with their present practices. But in today’s environment, it makes sense to explore all possibilities.
Chiesa Shahinian & Giantomasi PC By Nicole DiMaria, Esq., Member, Health Care & Hospital Group
While healthcare law is constantly in flux, it is trending toward efforts to foster greater consumer involvement in healthcare decision-making and increased price transparency with the overall goal of reducing healthcare costs. One of the major legislative efforts at both the state and federal levels is to place limitations on out-of-network balance billing and the reimbursement providers may receive for out-of-network emergency or other “surprise” services. In addition to advising our healthcare provider clients to generally keep abreast of the latest healthcare law developments, we are advising them to be prepared for a decrease in collection rates, particularly out-of-network providers, who can expect to face increasing pressure to be in-network.
Gibbons P.C. By Barry Liss, Esq., Director, Corporate Dept., Healthcare Team Leader
Uncertainty is nothing new to healthcare clients. They have had to adapt to substantial shifts in their economic, technological, and legal landscapes for decades. They know how quickly change can occur: the Affordable Care Act passed, U.S. Supreme Court upheld it and now its fate is unclear again. On the provider side, we expect welcome regulatory changes pertaining to fraud and abuse laws resulting from the “Regulatory Sprint to Coordinated Care.” Those changes should spawn new and innovative arrangements among providers, payors and other businesses in the sector. Key interest groups, i.e., providers, the executive branch and the legislative branch, seem to have sufficient common ground to actually change the law substantially On the pharma and device side, the future is more difficult to predict. The pharmaceutical industry seems poised to be pitted against the executive branch over issues such as pricing controls and pricing transparency. A political compromise might result in less than substantial change to that sector, notwithstanding the media attention those issues have garnered.
Lowenstein Sandler LLP By Michael Lerner, Esq., Chair, Life Sciences Group
Although no new legislation regarding drug pricing has yet passed, the traditional paradigm of pricing products in the life sciences industry has changed dramatically. The FDA has recently approved some life-changing treatments for rare genetic disorders and chronic conditions, but these products come with extremely high price tags. In this environment, pharmaceutical companies must consider the entire market while determining how to price their products; they must be cognizant of the needs of all the various parties within the payment chain. They must also strive to educate the entire market on the benefits of their products, quantifying the ability of their drugs to save lives plus be cost-effective in the context of other potential costs such as physician visits, hospitalizations, surgeries and other preventable procedures.
McElroy, Deutsch, Mulvaney & Carpenter, LLP By James A. Robertson, Esq., Partner, Chair, Health Care Practice
External forces will continue to change the way clinical care and life sciences are delivered and paid for, whether they involve governmental programs like Medicare for All or market-driven changes such as risk-shifting contracts. Change of any magnitude, however, won’t diminish demand for those products and services, which is likely to increase as the population ages over the next decade. Companies that succeed in this dynamic environment will recognize and move quickly to capture new opportunities and will also plan for all possible contingencies. Companies that rely heavily on intermediaries—such as healthcare payers, pharmacy benefit managers, employers, etc.—for distribution of their products or services will find it more difficult to compete. Our advice to life sciences and healthcare clients has been consistent over the past decade and is fairly straightforward: Don’t ever be comfortable with your current situation, because the industry fundamentals are constantly evolving. Always be flexible and open to new ideas and opportunities. In addition, running a tight ship with respect to financial, legal and regulatory matters should always be the priority.
NPZ Law Group, P.C. By David H. Nachman, Esq., U.S. Managing Partner
Competing healthcare visions, proposed new taxes, as well as price controls in the pharmaceutical industry could diminish the profitability of pharmaceutical companies and high-ranking health- care facilities based in the Garden State. New Jersey, which is home to 14 of the world’s 20 largest pharmaceutical companies, is contending with competition from similar markets which are emerging in China, Egypt, India, Mexico and Vietnam. We have assisted New Jersey-based pharmaceutical companies and healthcare facilities to hire highly skilled foreign workers from some of these emerging foreign markets. Through employment-based work visas and permanent residency of these highly skilled foreign workers, our firm has helped the state’s healthcare industry thrive by maintaining its competitive edge in R&D and science which, in turn, creates jobs for U.S. workers and increases the tax base in New Jersey.
Riker Danzig Scherer Hyland & Perretti LLP By Khaled J. Klele, Esq., Partner, Health Care and Commercial Litigation Groups
Many providers struggle with EMR vendors because they focus on the cost part of “cost-effective,” and end up constantly switching vendors and dealing with administrative headaches. Have a good EMR system so you can spend more time seeing patients. Also, small groups should not do their own billing. Billing has become so complicated that they offer college degrees on the subject, so many groups end up leaving money on the table or, worse, they get audited for billing irregularities. Hire an outside company that focuses on your practice area. In addition, for a group that wants to stay small, get leaner by outsourcing administrative functions so you can focus on patient care. For groups that want to grow, develop a multi-specialty group because becoming larger provides you with more bargaining power with payors. Providers should also investigate programs offered by CMS because many of these programs provide higher rates. Also, renegotiate your payor contracts. Many providers never attempt to re-negotiate their contracts, some for over a decade. Work with your billing company, or a consultant, to renegotiate higher rates every few years.
NJII Takes on Opioid Crisis, Bringing Behavioral Health into the Digital Age
The New Jersey Innovation Institute (NJII), a New Jersey Institute of Technology (NJIT) corporation, has joined in a new state-funded effort to combat the national opioid epidemic’s impact on New Jersey.
With support from a $6 million grant by the New Jersey Department of Health (NJDOH) and New Jersey Department of Human Services (NJDHS), the institute has announced it will help lead the statewide “Promoting Interoperability for New Jersey Substance Use Disorder Providers” initiative—a program designed to bolster the state’s health information technology infrastructure and incentivize a greater number of its substance use disorder (SUD) medical professionals to transition from traditional paper-based medical records to electronic health record (EHR) technology.
The new program specifically aims to address the persistent issue of opioid overprescribing that has contributed to the escalating epidemic by enhancing the management and communication of prescription opioid-related patient health records between behavioral health professionals, primary care physicians and hospitals through the state’s health data exchange system, called the New Jersey Health Information Network (NJHIN).
NJII will partner with the New Jersey Association of Mental Health and Addiction Agencies (NJAMHAA) to implement the rollout of the initiative, officially introduced by the NJDOH and NJDHS in April.
“The opioid epidemic has created devastating needs, one of which is the need to bridge the islands of health information that currently exist between our substance abuse doctors and the rest of the state’s health providers,” explains Tomas Gregorio, senior vice president of NJII’s Healthcare Division. “One major challenge during this epidemic has been the inadvertent overprescribing from doctors who may not know a patient has just been prescribed opioid medication and is trying to get more. Our goal with this initiative is to help these providers get connected.”
According to data published by NJCares.gov, dispensations of prescription opioids in New Jersey—such as morphine, oxycodone and fentanyl—totaled more than 4,800,000 in 2017. The National Institute on Drug Abuse reported that there were 1,969 drug overdose deaths involving opioids across the state that year—a rate of 22 deaths per 100,000 persons, which is 50 percent higher than the national rate. The state estimates that more than 3,000 individuals have died due to overdoses in 2018, with the greatest increase in cases attributed to potent synthetic opioids, such as fentanyl and its analogs.
Approximately 60 percent of SUD providers in New Jersey have reported that they require new EHR platforms or system upgrades, according to a 2018 survey by NJAMHAA.
Bionic Limbs: Connecting
Mind and Machine
Source: National Institutes of Health
When you lose the use of a limb, even the simplest of daily tasks can turn into a challenge. High-tech devices can help restore independence. New technologies are even making it possible to connect the mind to an artificial limb. These artificial limbs are called bionic prosthetic devices.
“To get back some of that lost function, you need some sort of assistive tool or technology to either enhance recovery or restore the capability of the anatomy that’s missing,” says Dr. Nick Langhals, who oversees NIH-supported prosthetic engineering research.
This fast-moving research aims to improve people’s lives by restoring both movement and feeling.
Prosthetic Control. Traditional prosthetic devices use a body-powered harness to control a hand device. These are easy to use. With a shrug of your shoulder, the prosthetic hand or hook opens. With the release of your shoulder, the prosthesis closes. Through the feel of the cable tension across your shoulders, you know whether the prosthesis is open or closed without looking at it.
Newer, motorized hands are not as easy to learn how to use. To close the device, you contract the remaining muscles in your arm. An electrical sensor placed over those muscles detects the contraction and tells the hand to close. Since the original muscles that controlled the hand are gone, the remaining muscles must be retrained. Learning how to open and close a prosthetic hand in this way takes some time. And you still need to watch the device to know what it’s doing.
To make motorized hands more intuitive to use, researchers are developing ways to detect the electrical signals in your brain and nerves to help control advanced bionic prosthetics. This can be done many ways, such as by implanting tiny sensors in the parts of the brain that control movement or by attaching small electrodes to the amputated nerves. Either way, the patients simply think about moving their hand and computers translate it into the movements of a bionic prosthetic hand.
Two-Way Communication. To regain a sense of wholeness, a person with a bionic limb needs to do more than control the device. They also need to “feel” what it’s doing. New bionic devices can send sensation from the device back to the brain. This allows a person with a bionic device to feel like they are using their own limb.
“The most important thing about the research that we’re doing is this sense of wholeness,” says Dr. Paul Marasco, a biomedical engineering researcher at Cleveland Clinic.
One way to help a person feel their prosthetic hand is to move the remaining sensory nerves from the amputated hand to the skin of the upper arm. You can then use small robots to press on the skin of the upper arm when the hand is touching something.
Marasco’s team devised a similar system to restore the feeling of movement, too. The bionic hand sends signals to a computerized control system outside of the body. The computer then tells a small robot worn on the arm to send vibrations to the arm muscle. These vibrations deep in the muscle create an illusion of movement that tells the brain when the hand is closing or opening.
Marasco’s team tested this feedback system with several people who had a hand prosthesis. The study participants were able to operate the bionic hand and know what position it was in just as well as with their natural hand. With this feedback system, they didn’t have to look at the bionic hand to know when it was open or closed, or when it was reaching for an object.
“We fool their brains into believing that the prosthesis is actually part of their body,” Marasco says. This advancement directly taps into the way that the brain senses movement, which helps improve the two-way communication between prosthetic device and mind.
Wearable Robots. Research teams are also trying to help people who have lost the use of their legs. By wearing a robotic device called an exoskeleton, some people with leg paralysis have been able to regain the ability to walk.
A group led by Dr. Thomas Bulea, a biomedical engineer at the NIH Clinical Center, created a wearable exoskeleton for children with cerebral palsy. Cerebral palsy is a brain disorder that makes it hard to stand up straight, balance, and walk. The motorized, robotic exoskeleton changes the way the children walk by helping them straighten their knees at key points during the walking cycle. While the exoskeleton can make walking easier, children must be able to navigate at least small distances on their own to use it.
“The ultimate goal really is to have a person wear this outside of our lab, or even outside of the clinical setting,” Bulea explains. “To do that you have to have a really robust control system that makes sure that the robot is behaving properly in all different kinds of environments.”
The team is now writing software so that the robotic device can be worn while navigating bumps in the terrain and other real-world conditions.
Finding the Right Device. “What I try to emphasize to people is that there are a lot of potential tools and technologies at our disposal to try and make people better, and they should explore them and consider embracing them,” Langhals says.